Anterior abdominal wall 'peritoneal recess'

Published Date: 19th July 2016

Publication Authors: Samad A

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Background

Chronic abdominal pain is a well-known cause of prolonged morbidity and patient frustration. Often it is managed symptomatically with high recurrence rate and no definite treatment.

Material and Methods

We present here a new potential space named as ‘Peritoneal Recess’ inside the abdomen which was found during diagnostic laparoscopy performed to look for the cause of recurrent abdominal pain.

Case Report

A middle aged patient presented with intermittent chronic abdominal pain without any obvious cause. All her investigations including small bowel studies were normal; however a recent CT scan raised the suspicion of an intra-abdominal hernia though there was no obvious lump on examination.

Result

A diagnostic laparoscopy was performed which revealed a left sided unilateral ‘Peritoneal Recess’ formed by a fold of peritoneum lying medial to linea-semilunaris and conforming to the curve of arcuate line ending up in a blind recess. No extra-peritoneal sac or defect was noted in the rectus sheath nor any contents were present in the recess. It seemed like the bowel was getting intermittently trapped inside the recess leading to partial kinking causing recurrent abdominal pain. By definition this is not a true hernia and we have named it as “Samad-Siddique’s pseudo-hernia”. The ‘Peritoneal Recess’ was closed with laparoscopic tackers to prevent bowel from further entering the ‘Recess’ which helped resolving the patient symptoms.

Conclusion

The ‘Peritoneal Recess’ may cause pseudoherniation of small bowel resulting in chronic abdominal pain. We recommend diagnostic laparoscopy for confirmation followed by endoscopic fixation of the recess.

Siddique, K; Samad, A. (2014).  Anterior abdominal wall 'peritoneal recess': Cause of chronic abdominal pain . European Surgical Research. 52 (3-4), 154.

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